Provider Demographics
NPI:1477045862
Name:BATES, CORY (LCSW, LCAS-A)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:BATES
Suffix:
Gender:M
Credentials:LCSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N ELAM AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1142
Mailing Address - Country:US
Mailing Address - Phone:336-832-9800
Mailing Address - Fax:336-832-1369
Practice Address - Street 1:510 N ELAM AVE STE 301
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1142
Practice Address - Country:US
Practice Address - Phone:336-832-9800
Practice Address - Fax:336-832-1369
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24678101YA0400X
NCP0125111041C0700X
NCC0131901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)